FORM A

Confirmation of beneficial ownership (UBO)

Private Individual

Art. 6 Para. 1 AMLA



The customer confirms with his signature that he is the sole beneficial owner for all assets that are used as part of a business relationship with Bitcoin Suisse AG (BTCS). This applies to all payment methods (crypto currencies included), which are referred to BTCS and all cash (crypto currencies included), which are referred by Bitcoin Suisse AG to the customer. The customer acknowledges, that an order is irrevocable after the payment amount for purchase/sale has been transferred.

(Filled by BTCS)



The client herewith confirms that she/he is not a PEP (politically exposed person) nor is she/he related to any PEP. The client furthermore confirms that she/he is not a US citizen, green card holder or resident of the United States of America. The customer is obliged to inform BTCS about any changes in the above data.

                                               Place and Date
                                            Customer signature

Knowingly providing false information on this form constitutes a criminal act (Art. 251 of the Swiss Penal Code, forgery may be subject to imprisonment for up to 5 years or a fine).